P857: COMPARISON OF MULTIPLE MYELOMA TREATMENT PATTERNS IN 2022 ACROSS UNITED STATES, SOUTH AMERICA, EUROPE AND ASIA
Authors: Simone Rivolo, Philippe Capart, Agnes Benedict
Journal: HemaSphere (2023)

Topic: 13. Myeloma and other monoclonal gammopathies - Biology & Translational Research Background: Multiple myeloma (MM) treatment patterns have become increasingly complex, with multiple triplets or quadruplets available for physician choice in front line (1L), subsequently driving the available treatment choices in second-line (2L) and from third-line onwards (3L+). Aims: This study investigates geographic differences in drug therapies for MM across North and South America (Brazil, Mexico, United States [US]), Europe (France, Germany, Italy, Spain), United Kingdom (UK) and Asia (China, Japan) by examining treatment patterns in the first three lines of therapy, between January and December 2022. Methods: Patients with MM, that received at least one line of therapy in 2022, were identified from OncoLocator™, a live database of patient charts across 25 oncology indications. For each patient, the type of therapy received, and the line of therapy were extracted and analyzed. Results: A total of 8,519 patient charts were identified, with minimum 119 charts/country, for each line (1L: N=124-358; 2L: N= 136-391; 3L+: N=119-338). Among the total cohort, 68% of patients have Stage III cancer and 19% of patients have received concomitant radiation therapy (24% in 1L, 26% in 2L and 50% in 3L+). In front-line MM (Figure 1), quadruplets were the most common regimen, with D-VTd (Daratumumab [D-] + bortezomib [V] + thalidomide [T] + dexamethasone [d]) predominant in Germany (37.9%), UK (41.6%) and Italy (28.9%), while D-RVd (lenalidomide [R]) most common in France (28.3%). Triplets were the most prevalent regimen in the other countries analyzed, with VCd (cyclophosphamide [C]) most common in Brasil (59.1%) and Mexico (31.1%), VRd/RVd in Spain (36.1%), CRd in US (27.5%) and Japan (17.6%) and VDd (doxorubicin [D]) in China (49.2%). Across all countries, except China, quadruplets were among the five most common 1L regimens, with early adoption of quadruplets in the OncoLocator™ database likely related to the relatively high proportion of physicians from academic settings. In 2L MM, D-Rd was the most common regimen in the EU4 (20.2% - 50.9%), D-Vd in Brasil (19.8%) and UK (21.1%), D-Pd (pomalidomide [P]) in Japan (10.1%) and US (15.5%), while carfilzomib [K] regimens were most common in Mexico (KRd) and China (KPd). Quadruplets were rarely used in 2L across countries, with only China showing a quadruplet (D-VCd: 11.8%) among the five most common 2L regimens. In 3L+ MM, treatment patterns were fragmented, with D-based combinations being prevalent in US (D-Pd: 11.5%), Spain (D-Rd: 10.3%), Mexico (D-Rd: 11.8%) and Brasil (D-Vd: 11.7%), while KPd most commonly used in Germany (11.3%) and France (25%). Ixazomib [N] triplets were the most frequent 3L choice in UK (NRd: 49.7%) and Japan (PNd: 11.4%), VPd in China (17.5%) while elotuzumab [E] was most prevalent in Italy (EPd: 9.6%). Data are currently being collected focusing on therapy received by stem cell transplant (SCT) eligibility, so that treatment patterns can be analyzed stratified by SCT eligibility. Interviews of 5 physicians are then planned to discuss the differences observed across countries. Summary/Conclusion: Contemporary real-world evidence on MM treatment landscape across the world shows that treatment patterns remain heterogeneous across countries, with the heterogeneity increasing from 2L onwards.Keywords: Treatment, Multiple myeloma, Real world data